Got a date :)...with a HUGE if :( !!

[AndreaP 0]

My insurance doesn't do prior authorizations, they only require that the surgeon certify I meet criteria on the day of surgery.

Today I meet their criteria and got a surgery date...yeah! Then comes the BIG IF....the insurance company is changing the criteria and when they do, I won't qualify. The problem is that the doctor's office doesn't know if they are changing it December 1st or January 1st and the earliest surgery date I could get is December 5th.

So...I am going to my last 2 pre-op appointments and starting the pre-op diet on November 21st, but they may cancel my surgery on December 1st or 2nd

Anyone have any similar circumstances? I want so much to get excited but I don't want to have a huge let down.

Right now I think one of the hardest pre-op things will be not having Thanksgiving dinner this year. I know it will be worth it in the end, but I still think it will be a hard day.

[longer-life 139]

Hmmmm I would be looking for a surgeon of excellence in my area first thing in the morning and having surgery before December 1st! At a minimum consider calling your insurance and see if you get a straight answer. I would still not trust it though. Good luck!!!!!

[cortknee98 2]

AndreaP,

I am in Traverse City and am having a similar issue! I have BCBS of MI and I got a letter in October saying that I do not need the 6 month medically supervised weight loss program, BUT I called a few days ago and now apparently I DO need it. I've been working with Grand Traverse Surgery and have my first appointment with Dr. Nizzi next week. I am freaking out! I don't want to have to wait another 6 months. :banghead:How frustrating!! Good luck to you. Let's exchange prayers!!!

[AndreaP 0]

cortknee98,

I am in Petoskey...not far from you!! Do you know if your BCBS is a PPO?? I have not gotten any letters from BCBS. I have called and talked to customer service a couple of times and everytime I do I get a different answer.

I am freaking out too!!! If BCBS told you that you don't need the medically supervised weight loss program and now they are saying you do, it sounds like the same thing I'm dealing with. The rep told me no in Sept and yes the other day. Now according to the Dr's office it is going to change soon, but they don't know when. I went ahead and scheduled but I think it's going to be a long, stressful wait until Dec. 1st.

I think exchanging prayers is a good idea!!!

If you hear anything else will you please post to this thread? I will do the same!!

[AndreaP 0]

Longer-life -

Thanks for the post. I see you're only 8 days out....good luck to you and wishes for a speedy recovery.

I wish it was as easy as finding a new surgeon. I'm in Northern Michigan and there are very few options!!!

Now, or in six months, it will happen and I have to believe it will work out the way it is supposed to.

[longer-life 139]

Ohhhh, you didn't mention in your original post that it could happen in 6 months! I thought you would have to self pay. Gotcha now! Thanks for your well wishes and right back at ya! :smile1:

[AndreaP 0]

Longer-life,

Sorry about that omission...I'm sure my first post was confusing. It is only a six month delay if it happens. It's just so frustrating because my insurance has been telling me there isn't a six month weight loss program requirement and now they are changing at the last minute. If I had known about it, I wouldn't have had everything else done such as my bloodwork and getting clearance from my pulmonologist, an endoscopy, etc.

If I have to wait the six months, some of these will have to be repeated and I will have the expense all over again. Still not as expensive as self-pay though...

Thanks again for your input....let us know how you make out with your surgery!!

[5DogMa 62]

Cortknee98 & AndreaP - I'm having similar issues with BCBS. Customer service told me several times by different people NO 6 month wait period and they told the doctors office there was when they called in to verify coverage. They told them 6 consecutive montly office visits. After my doctors office told me this, I called customer service again and again they told me NO waiting period just need to meet the BMI requirement. Well, we submitted last week for approval and I am penciled in Dec 7th for surgery. I started seeing my doctor in May but missed 1 appt in July because I was moving. My doctors office said we are taking a gamble they won't notice the 1 missed appt. I have a co-worker who had RNY 2 years ago and she didn't have to wait 6 months. URGH!

[5DogMa 62]

^{Oh, don't most insurance companies change things starting in January of the new year? I've never experienced one changing things in December.}

[cortknee98 2]

AndreaP.

I DO have a PPO! I think I'm just going to have the surgery scheduled and cross my fingers. I did go to my PCP the other day to speak to her about everything that is going on and she said that we could count my first appointment (where I asked for my referral letter) as the first month, and the current appointment as the scond month. I made an appointment for Dec, just in case. I figure that if BCBS is going to make me do this, I'll at least have 3 months under my belt. Any news from your insurance yet? Thinking about you!

[Sassygirl06 962]

most policy changes happen on the first of the year, just like new laws. i would double check to make sure, but that would make more sence. good luck!

[LoserMama 37]

I hope you get an answer, weird to think of a company not changing its policy terms on the start of a new year. I think most do, but heck, there are probably odd balls out there.

(BTW, my husband is from Traverse City, so I am very familiar with TC and Petoskey....( :)

[LindaS 316]

Andrea P and Cortknee98, I'm from northern Michigan too, but a bit south of both of you. I live near Houghton Lake. I was sleeved in August, and I have BCBS. I didn't need a 6-month waiting period.

I know at the support group I went to last night, they were talking about changes. I hope it all goes well for both of you.

I am very happy with my sleeve!

[AndreaP 0]

^{Thank you all for the support and good wishes.}

^{I haven't heard anything else, but really don't expect to before Dec 1st.}

^{Cortknee98...I'm glad to hear you are getting your appts started just in case.}

^{Glad to hear there are others out there who know where Petoskey and Traverse City are :smile1:}

^{If anyone hears more about this insurance, please post. I'll keep checking and posting myself.}

^{Oh...and it's snowing!!!!}

[AndreaP 0]

Thanks all for your comments and support......

Just a follow-up to let you know the insurance company didn't change their criteria and I had my surgery on December 5th.